Infectious disease

Question 1

SIRS criteria

Answer 1

• Temperature >38 or <36
• Tachycardia
• Respiratory rate over 20 or PCO2 under 32
• WBC over 12 or under 4

Question 2

Organs in dysfunction in sepsis

Answer 2

Hypotension, AMS, increased creatinine, LFTs

Question 3

Therapy goals for sepsis?

Answer 3

Goal directed therapy

• CVP 10-12 mm Hg
• MAP >65 mmHg
• U output of 0.5 cc/kg/hr
• SvcO2 over 70

Question 4

What are the therapy actions needed to correct sepsis?

Answer 4

• Blood cultures should be drawn prior to sepsis
• Eliminate source of sepsis
• 30cc/kg bolus fluid challenge
• If fail fluid challenge - need pressors
• Maintian oxygenation as needed
• Empiric abx while waiting for cultures

Question 5

Want to treat anaerobes?

Answer 5

Depends on location of bugs

• Gut and vagina: metro
• Everywhere else: Clindamycin

Question 6

Staph infection? MRSA? UTI?

Answer 6

• Staph: Nafcillin
• MRSA: Vanc
• UTI: Ampicillin or ciprofloxycin (Flagyl)

Question 7

Generations of quinolone and coverages

Answer 7

• 1st gen - ciprofloxacin: gram negative (UTI) only
• 2nd gen - levo: gram negative coverage
• 3rd gen - moxi: gram negative and positive

Question 8

Penicillin allergy alternatives

Answer 8

If rash: Cephalosporins

If anyphylaxis: DONT go cephalosporin

Question 9

Pseudomonas coverage

Answer 9

Pip/tazo (zosyn), carbapenems, cefepime

Question 10

Outpatient pneumonia treatment

Answer 10

Doxycycline, azithryomycin moxifloxacin

Question 11

Inpatient pneumonia drugs

Answer 11

• 3rd gen cephalosporins + azithromycin for CAP
• Vanc + Zosyn (pip/tazo) for HAP

Question 12

Neutropenic fever drugs

Answer 12

• 4th gen cephalosporin (cefepime)
• Carbapenems

Question 13

UTI drugs

Answer 13

TMP-SMX, nitrofurantoin

Question 14

Meningitis treatment

Answer 14

Vanc, ceftriaxone +/- steroids, +/- ampicillin

Question 15

Cellulitis drugs

Answer 15

Cefazolin, bactrim, clindamycin, IV Vancomycin

Question 16

CENTOR criteria

Answer 16

CENTOR

• Absent Cough
• Exudates
• Nodes
• Temp (fever)
• OR - young = +1 and old = -1

Question 17

Strep bovis origin? What does it cause?

Answer 17

Bovis comes from the colon and can cause endocarditis

Question 18

Staph aureus origin and what can it cause in the heart?

Answer 18

IVDA cause tricuspid valve vegetations from skin flora

Question 19

Oral flora?

Answer 19

Strep everything

Question 20

Dukes criteria

Answer 20

Criteria for infective endocarditis

• Major
  
  • Sustained bacteremia by organism known to cause IE
  • Endocardial evidence by Echo
  • New valvular regurgitation
• Minor
  
  • Predisposing risk factors
  • Fever > 38
  • Vascular Phenomena
  • Immunologic phenomena

Question 21

Which organisms cause acute endocarditis?

Answer 21

Staph, strep pneumo which infect normal native valves

Question 22

What is the presentation of acute endocarditis? How is this diagnosed?

Answer 22

• New murmur in a patient who is sic with persistent bacteremia leading to valve destruction.
• Diagnose with a unch of cultures to watch for clearance and start antibiotics right away

Question 23

What is the presentation of subacute endocarditis?

Answer 23

• Roth spots in the eyes
• Janeway lesions (painless hands)
• Splinter Hemorrhages (Nailbeds)
• Osler nodes (Painful distal digit pulp)

Question 24

How is infective endocarditis diagnosed?

Answer 24

• Acute: Keep getting cultures until bacteremia clears but then get a TEE
• Subacute endocarditis: Get a culture when you notice lesions. Bacteremia? Get a TEE

Question 25

How long is infective endocarditis treated?

Answer 25

6 weeks

Question 26

How is infective endocarditis treated with antibiotics in a native valve?

Answer 26

Vanc

Question 27

What is the antibiotic regimen for prosthetic valves?

Answer 27

* \<60 days: Vanc, gent, cefepime * 60-365: Vanc, gent * Over 365: Vanc, gent, ceftriaxone

Question 28

When does an endocarditis valve need to go to surgery?

Answer 28

* \>15 mm without embolization * \>10 mm + embolization * Abscess * Valve destruction or CHF * Fungus

Question 29

What are the prophylaxis measures for a bad valve?

Answer 29

Congenital heart disease, prosthetic valve, history of endocarditis? * Amoxiciillin * Cefazolin * Clindamycin

Question 30

What are the prophylaxis measures for a dental procedure?

Answer 30

Amoxicicillin Cefazolin Clindamycin

Question 31

Treatment for urethritis

Answer 31

* Ceftriaxone + Doxy or Azithromycin

Question 32

What is the treatment for cystitis?

Answer 32

TMP-SMX or Nitrofurantoin or fosfomycin

Question 33

What is the treatment for pyelo

Answer 33

IV cephalosporin if inpatient or PO fluoroquinolones outpatient

Question 34

What is the treatment for a urinary tract abscess

Answer 34

Drain it and use IV cephalosporin inpatient or PO FQ outpatient

Question 35

What do you do after treating someone who is pregnant with a UTI?

Answer 35

Confirmation of eradication by urine cultures

Question 36

Treatment difference between complicated and uncomplicated urethritis

Answer 36

Uncomplicated? 3 days. Complicated? 7 days

Question 37

What is the treamtent for cellulitis?

Answer 37

Group A strep and Staph aureus infection, so use first gen cephalosporin or antibiotics that cover MRSA like bactrim or clindamycin

Question 38

What causes you to suspect meningitis? What do you do after?

Answer 38

* Check for fever and headache * Blood cultures, Antibiotics and Lumbar puncture

Question 39

What LP findings show bacterial meningitits? What do you do after you find this?

Answer 39

* Increased cell count with tons of neutrophils * Decreased glucose * Increased protein * Tx: Ceftriaxone, vanc, steroids and ampicililn if immunocompromised

Question 40

What will make you think encephalitis and not meningitis?

Answer 40

Fever, headache and confusion

Question 41

What should be considered before doing an LP?

Answer 41

FAILS menmonic * F: Focal neurological deficits * A: AMS * I: Immunocompromised * L: Lesion * S: Seizures

Question 42

How is the definitive diagnosis of HSV made?

Answer 42

PCR

Question 43

What should clue you in to an abscess vs cancer?

Answer 43

Brain biopsy is needed and will show organisms in an abscess requiring drainage or cancer requiring radiation and chemo

Question 44

Presentation of syphilis and test to confirm?

Answer 44

* Presentation: Painless firm ulcer with lymphadenopathy * Test: * Primary: Dark field * Secondary: RPR * Tertiary: LP

Question 45

Presentation and tests for Ducreyi?

Answer 45

Painful singular ulcer with lymphadenopathy. Gram stain and culture

Question 46

What is the presentation and test for LGV?

Answer 46

Painless singular ulcer that requires no test

Question 47

What is the presentation and test to confirm herpes?

Answer 47

Roofed painful vesicles with an erythematous base tested with HSV PCR

Question 48

2+1 treatment for HIV

Answer 48

2NRT-I and 1 of the following... * 1 NNRTI * 1 PI/r * 1 Integrase inhibitor * 1 Fusion inhibitor

Question 49

What drugs are in PrEP? PEP? What HIV drug do you use in pregnancy?

Answer 49

* PrEP: Emtricitabine and tenofovir * PEP: EMtricitabine and tenofovir +/- Raltregravir * Pregnancy: AZT at the time of delivery

Question 50

Define AIDS

Answer 50

CD4 under 200 or the presence of an opportunistic infection

Question 51

When do you have to prophylax for PCP pneumonia and what do you do?

Answer 51

1st bactrim then dapsone (if allergic to bactrim) then atovaquone (if G6PD deficient) at CD4 level 200

Question 52

When do you prophylax for toxo and what do you do?

Answer 52

Bactrim and pyrimethamine at under 100

Question 53

When do you prophylax for MAC?

Answer 53

Azithromycin at CD4 under 50

Question 54

What are the RIPE side effects?

Answer 54

* R: Red Urine * I: Neuropathy * P: Hyperuricemia and gout * E: Eye disturbance

Question 55

What is the presentation of tuberculosis

Answer 55

Night sweats, fever, weight loss, hemoptysis and cough

Question 56

What is the diagnostic process of tuberculosis?

Answer 56

* Asymptomatic screen performed on people who arent symptomatic but require proof of their absence of exposure * If positive exposure then do chest xray * If this is positive then the person is infected and need an AFB Smear * If positive then active infection and ripe * If negative then INH + B6 x 9 months * If negative then INH + B6 x 9 months

Question 57

What are the cutoffs for + PPD screening

Answer 57

* 5 mm (immunosuppressed) * HIV, organ transplant, steroids, TB * 10 mm "exposed" * Incarcerated * Healthcare provider * Endemic areas * 15 mm "not exposed"